神经内镜联合利奈唑胺在脑室-腹腔分流术后重度颅内感染的应用研究  

Application of Neuroendoscopy Combinded with Linezolid in Severe Intracranial Infection after Cerebral Ventriculo-peritoneal Shunt

作　　者：呼铁民[1] 王维兴[1] 王昆鹏[1] 孙文浩[1] 李亮[1] 赵宗茂[2] 

机构地区：[1]承德医学院附属医院神经外科,河北省承德市067000 [2]河北医科大学第二医院神经外科

出　　处：《中国全科医学》2015年第6期692-695,共4页Chinese General Practice

摘　　要：目的探讨神经内镜联合利奈唑胺对脑室-腹腔分流术（V-PS）后重度颅内感染的效果。方法选取2006年1月—2009年12月河北医科大学第二医院收治的37例V-PS后革兰阳性球菌重度颅内感染患者为对照组;2010年1月—2013年12月收治的40例患者为治疗组。77例患者均接受神经内镜下脑室灌洗术,对照组术后给予0.5%盐酸万古霉素溶液静脉滴注;治疗组给予利奈唑胺静脉滴注。观察两组术后7、14 d治疗效果,术前、术后14 d脑脊液（CSF）中白细胞计数（WBC）、蛋白、葡萄糖水平,细菌清除率及并发症发生情况。结果两组术后7、14 d治疗效果比较,差异均无统计学意义（P〉0.05）。对照组用药时间6-26 d,平均（12.3±2.1）d;治疗组5-20 d,平均（9.8±1.4）d;两组用药时间比较,差异有统计学意义（t=6.87,P=0.031）。两组术前、术后14 d CSF中WBC、蛋白、葡萄糖水平比较,差异均有统计学意义（P〈0.05）;其中治疗时间与治疗方法无交互作用（P〉0.05）;组间比较,差异均有统计学意义（P〈0.05）;时间间比较,差异均有统计学意义（P〈0.05）。治疗组与对照组治疗后均未在CSF中发现革兰阳性球菌,细菌清除率为100.0%。神经内镜下脑室灌洗术后未见癫痫、头痛等并发症。电话或门诊随访1年,未见颅内感染复发。结论神经内镜下脑室灌洗术治疗V-PS后重度颅内感染疗效良好,利奈唑胺能有效控制革兰阳性球菌感染,且安全性好。Objective To investigate the effect of neuroendoscopy combinded with linezolid in severe intracranial infection after cerebral ventriculo- peritoneal shunt（ V- PS）. Methods 37 cases with severe intracranial gram- positive cocci infection after V- PS who were treated in the Second Hospital of Hebei Medical University from January 2006 to December 2009,were included in control group; 40 cases with the same disease in the same hospital from January 2010 to December 2013,were included in treatment group. The cases in control group were treated with 0. 5% vancomycin hydrochloride solution through an intravenous drip after V- PS,the cases in treatment group were treated with linezolid through an intravenous drip. The therapeutic effects of two groups were observed 7 days and 14 days after surgery,respectively; the levels of WBC,protein and glucose in CSF,bacterial eradication rate and the occurrence of complications were recorded before surgery and 14 days after surgery. Results 7 days and 14 days after surgery,there was no significant difference in therapeutic effects between two groups（ P〉 0. 05）. The duration of medication in control group was 6- 26 days,the average medication duration was（ 12. 3 ± 2. 1）days; the duration of medication in treatment group was 5- 20 days,the average medication duration was（ 9. 8 ± 1. 4） days;there was significant difference in duration of medication between two groups（ t = 6. 87,P = 0. 031）. Before surgery and 14 days after surgery,there were significant differences in levels of WBC,protein,and glucose in CSF between two groups（ P 0. 05）;the duration of therapy was no significantly interacted with therapeutic method（ P〉 0. 05）; there was significant difference in the above indicators between two groups（ P〈 0. 05）; there was significant differences in the above indicators between two different time points（ P〈 0. 05）. After treatment, gram- positive cocci was not found in CSF of patients in both groups, bacterial eradication rate was 100. 0%

关 键 词：中枢神经系统感染 腹腔静脉分流术 利奈唑胺 

分 类 号：R74[医药卫生—神经病学与精神病学]